Joseph L. Kannry

Physician Satisfaction with Two Order Entry Systems

Objectives: In the wake of the Institute of Medicine report, To Err Is Human: Building a Safer Health System (LT Kohn, JM Corrigan, MS Donaldson, eds; Washington, DC: National Academy Press, 1999), numerous advisory panels are advocating widespread implementation of physician order entry as a means to reduce errors and improve patient safety. Successful implementation of an order entry system requires that attention be given to the user interface. The authors assessed physician satisfaction with the user interface of two different order entry systems—a commercially available product, and the Department of Veterans Affairs Computerized Patient Record System (CPRS).nnDesign and Measurement: A standardized instrument for measuring user satisfaction with physician order entry systems was mailed to internal medicine and medicine-pediatrics house staff physicians. The subjects answered questions on each system using a 0 to 9 scale.nnResults: The survey response rates were 63 and 64 percent for the two order entry systems. Overall, house staff were dissatisfied with the commercial system, giving it an overall mean score of 3.67 (95 percent confidence interval [95%CI], 3.37–3.97). In contrast, the CPRS had a mean score of 7.21 (95% CI, 7.00–7.43), indicating that house staff were satisfied with the system. Overall satisfaction was most strongly correlated with the ability to perform tasks in a “straightforward” manner.nnConclusions: User satisfaction differed significantly between the two order entry systems, suggesting that all order entry systems are not equally usable. Given the national usage of the two order entry systems studied, further studies are needed to assess physician satisfaction with use of these same systems at other institutions.

Personal Health Records: Meaningful Use, But for Whom?

Providers and hospitals have received more than

Effect of e-prescribing systems on patient safety.

5 billion from the federal government for meaningfully using electronic health records as of April 2012. Meaningful Use stage 1 makes adoption of the personal health record optional. The proposed Meaningful Use stage 2 regulations make personal health record use mandatory. There is peer-reviewed literature to support a personal health record adoption rate of 10%, which is optional in stage 1 and required in stage 2. The literature also supports the use of secure messaging required in stage 2. However, there is little evidence to support other stage 2 personal health record requirements and dependencies. Further study is urgently needed to ensure that Meaningful Use stage 2 is meaningful for both patients and providers.

Deriving Long-Term Value from Context-Aware Computing

E-prescribing systems enable electronic transmissions of prescriptions to pharmacies from the providers office. The promise of e-prescribing in regard to patient safety is reduction in the time gap between point of care and point of service, reduction in medication errors, and improved quality of care. This article will give a brief overview of e-prescribing systems, what is known about these systems and their impact on patient safety, and what challenges remain. For purposes of this article, the term patient safety will be used interchangeably with medication errors and adverse drug events. Although there is some evidence that e-prescribing alone and e-prescribing with medication decision support can reduce medication errors, there is also evidence that e-prescribing can be a source of medication errors. The need for more study is particularly relevant and timely, as the Centers for Medicare and Medicaid Services is strongly incentivizing providers to use e-prescribing with medication decision support. Despite concerns about efficiency and dissatisfaction, the majority of providers believe e-prescribing provides for improved patient safety. Limited evidence suggests that e-prescribing with medication decision support can improve patient safety.

Healthcare [Guest editors' introduction]

Abstract Modern businesses are increasingly dynamic in nature, which creates a need for computer systems that can sense and respond to rapid changes in the environment, or “context,” of the enterprise. This article presents the authors vision of a context “ecosystem” that helps enterprises, applications, and developers respond to these dynamic changes and derive long-term value from context information. the ecosystem includes providers of raw context information, components that derive more abstract context information from lower level sources, middleware that provides systematic context services to applications, development tools, and contextaware applications.

Predicting changes in workflow resulting from healthcare information systems: ensuring the safety of healthcare.

W e’re moving closer to realizing pervasive computing devices that can monitor our health status, both individually and as a community. Imagine what doctors could do with ECG data collected on a more regular basis, as people carry on their daily activities. The ability to monitor day-to-day heart data would profoundly affect how the medical community tracks our individual health status. Likewise, organizations such as the Centers for Disease Control wouldn’t have to collect data from reports generated by hospitals and doctor’s offices if we could instead collect data about people’s behavior directly from the devices they use daily. Furthermore, we could then analyze that data to detect communicable diseases. However, with each such advance and the perceived health benefits, we must consider the related privacy risks and potential for data overload. The articles in this special issue show us the technological capabilities that might be available to future healthcare providers and how they might be integrated into our daily lives.